Provider Demographics
NPI:1891142394
Name:ALBANESE, DUSTIN EVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:EVAN
Last Name:ALBANESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 MINDY LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7152
Mailing Address - Country:US
Mailing Address - Phone:561-756-4301
Mailing Address - Fax:
Practice Address - Street 1:6495 SHILOH RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1635
Practice Address - Country:US
Practice Address - Phone:770-851-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor